Archives of Clinical Infectious Diseases
Volume:18 Issue: 2, Apr 2023

Q fever is a naturally occurring zoonotic disease with a zoonotic range covering all continents of the globe. The reservoirs and vectors of Coxiella burnetii are ixodid ticks and their hosts. This disease is characterized by a variety of mechanisms and routes in humans and animals (e.g., vector-borne, foodborne, airborne, and dust-borne). The disease often runs in the form of a fever. This article will review the incidence of human Q fever on the Eurasian continent over the past 50 years. Because Q fever is one of the unobserved infectious diseases, the occurrence of Q fever in humans in most countries is impossible to evaluate. Since this literature review is the primary resource for tracking scientific trends and research findings on the subject, the main goal of this study has focused on estimating the index of the incidence of Q fever infection among humans and compiling a 50-year literature review from August 1973 to July 2022. This study investigated the articles published in PubMed, Scopus, CyberLink, Web of Science, and Google Scholar by reviewing the scientific literature and official systematic reviews. The data were obtained using the keywords “Q fever AND prevalence/incidence” and “Q fever AND epidemiology.” The incidence of Q fever varies considerably from country to country due to epidemiological differences and whether the disease is detectable or not. Depending on the location of the country, endemics or outbreaks occur. At the Third World Health Forum in 1950, the possible danger of Q fever to human health was realized, and decisions were made stimulating research into the global prevalence of the causative agent of the disease. Since then, numerous epidemiological studies have shown that Q fever occurs almost everywhere worldwide except in Antarctica and New Zealand. This review’s available literature and ongoing epidemiological investigations in many countries show that Q fever needs to be regarded as a global community health issue. However, in the case of Kazakhstan, there is currently no information on the incidence of infection in humans and farm animals that requires further research on the incidence of Q fever, especially in coronavirus disease 2019.

 The serious outbreak of coronavirus disease 2019 (COVID-19) has provoked deep concern throughout the world. The pathophysiologic network leading to severe conditions has still unsolved gaps. Considered a pleiotropic, multifaceted cytokine, macrophage migration inhibitory factor (MIF) has distinct functions, which seem to stand at the edge of distinct known mechanisms involving in COVID-19 pathogenesis. Additionally, MIF is a key mediator of acute respiratory distress syndrome and lung injury.

 The current study aimed to evaluate the serum levels of MIF in COVID-19 patients, particularly in severe cases.

 This case control study was performed on the sera of 60 randomly selected COVID-19 patients as case group and 30 randomly selected healthy individuals as control group during November 2020 till April 2021 at Mashhad University of Medical Sciences. The case group included 30 outpatients with mild disease and 30 hospitalized severe subjects. A commercial enzyme-linked immunosorbent assay was utilized to measure serum MIF. Data were analyzed using SPSS version 16 with student t-test and chi-squared test considering a P < 0.05 as statistical significance level.

 There was no statistical difference between two groups regarding demographic variables. According to the obtained data, significantly higher MIF levels were observed in the affected subjects than the healthy individuals, particularly in severe COVID-19 subjects (severe: 65.31 ± 6.2 ng/mL, mild: 40.45 ± 6.6 ng/mL, healthy: 20.63 ± 6.1 ng/mL P < 0.0001). The receiver operating characteristic (ROC curve) drawn for the present study illustrates that MIF amounts differentiate COVID-19 severe and mild cases with high accuracy (90.8%) (sensitivity:86.6%, specificity:96.6%).

 There might be an association between MIF concentration with respiratory failure and disease exacerbation due to COVID-19 infection. Therefore, MIF can act as a marker of clinical severity for COVID 19 infection. However, due to variations in MIF amounts a definite cut-off value might be specific to the study and should be considered with caution. MIF is supposed to be one of the most important cytokines in COVID-19 pathogenesis and might be a target for therapeutic approaches with MIF inhibitors in possible upcoming disease peaks.

 This study aimed to estimate the prevalence of fosfomycin resistance and the frequency of extended-spectrum beta-lactamase (ESBL) production in Escherichia coli isolates from three kidney transplant patients (KTPs) in Tehran.

 Sixty clinical isolates of uropathogenic E. coli were collected from three kidney transplant centers in Tehran between April and May 2019. Antimicrobial susceptibility testing (AST), minimum inhibitory concentration (MIC) of fosfomycin, and screening for ESBL production were conducted following the protocols established by the Clinical and Laboratory Standards Institute (CLSI). The presence of the blaTEM, blaSHV, blaCTX-M, fosA3, and fosC2 genes was evaluated using polymerase chain reaction (PCR) and sequencing. Additionally, mutations in the murA, glpT, uhpT, and cya genes were assessed. The activity of the carbohydrate phosphate transporter was measured using the real-time PCR assay.

 According to the AST results, ampicillin showed the highest resistance rate (86%), while ertapenem and doripenem exhibited complete susceptibility (100%). According to the E-test, 1.6% of E. coli isolates were resistant to fosfomycin. Furthermore, 33.4% of E. coli isolates in KTPs were ESBL producers, with the most frequent occurrence of the blaTEM gene (55%). Additionally, mutations were identified in the murA, uhpT, and glpT genes of resistant samples. No plasmid genes for fosA3 and fosC2 were detected. The expression of the uhpT gene increased 32-fold in a susceptible isolate, as determined by qPCR.

 The high resistance of E. coli isolates from urinary tract infections (UTIs) of KTPs to β-lactam antibiotics remains a significant clinical challenge. However, no correlation was found between ESBL production and resistance to fosfomycin. The resistance rate to fosfomycin was low, and the primary cause of resistance was mutations in chromosomal genes.

 Brucellosis, also known as malt fever, poses significant health and economic challenges across various regions worldwide, particularly in Mediterranean and Middle Eastern countries.

 This study aimed to identify cases of undiagnosed brucellosis among psychiatric patients.

 This descriptive cross-sectional study was conducted at Golestan Hospital in Ahvaz, Khozestan Province, Iran. The study aimed to investigate cases of undiagnosed brucellosis among psychiatric patients during the first six months of 2021. The diagnosis of brucellosis relied on standard tests, namely the Wright test, the Coombs-Wright test, and the two-mercaptoethanol test, which are widely recognized as reference techniques. In the endemic region of Iran, a positive titer of at least 1: 80 in the Wright test and titers of at least 1: 40 in the two-mercaptoethanol test are considered diagnostic criteria. The Coombs-Wright test is deemed positive when the titer is three dilutions higher than the Wright test titer in symptomatic patients.

 A total of 225 patients admitted to psychiatric wards with psychiatric disorders underwent examination for brucellosis. The study revealed an undiagnosed brucellosis prevalence of 7.6% (n = 17). None of these patients had a recent or prior history of brucellosis, nor had they received any treatment for the disease. Among the seventeen patients, three reported experiencing typical and commonly observed symptoms of brucellosis, such as myalgia and arthralgia, during the clinical interviews. However, the remaining fourteen patients did not display any clinical symptoms typically associated with brucellosis, including myalgia, arthralgia, fever, and sweating. Instead, they solely exhibited psychiatric symptoms alongside their condition.

 Based on the findings, it can be deduced that among the 225 patients diagnosed with psychiatric disorders, 14 individuals were identified as having brucellosis. Remarkably, these patients did not exhibit the characteristic symptoms typically associated with brucellosis. Instead, their manifestation of brucellosis presented solely as psychiatric symptoms.

 Staphylococcus aureus with concurrent resistance to antibacterial agents is emerging globally. This emergence might be due to the production of different virulence determinants, notably Panton-Valentine leukocidin (PVL).

 This study aimed to investigate the genetic characteristics of PVL-positive S. aureus strains isolates from clinical samples.

 An epidemiological study was conducted on 65 S. aureus isolates carrying pvl genes. An antibiogram test by the disk diffusion and broth microdilution methods was conducted to assess antimicrobial resistance profiles.

 All detected methicillin-resistant S. aureus (MRSA) isolates were confirmed by mecA polymerase chain reaction (PCR) assays. The PVL-positive isolates were characterized using multiplex PCR assay to detect staphylococcal cassette chromosome mec (SCCmec) and agr types. The PVL frequency was 19.5% and 17.6% in MRSA and methicillin-susceptible S. aureus (MSSA), respectively. Among the PVL-positive isolates, 66.2% and 33.8% were MRSA and MSSA, respectively. Multidrug resistance amounted to 84.6% of the isolates (MRSA: 61.5%, MSSA: 23.1%). Staphylococcal cassette chromosome mec III was dominated (55.8%; 24/43). The most commonly identified agr was type III (53.8%; 35/65). Resistance to vancomycin amounted to 12.3% of the isolates, and all belonged to agr type III and SCCmec type III. The frequency of inducible and constitutive clindamycin resistance among PVL-positive MRSA strains (12.3% and 26.1%) was higher than PVL-positive MSSA strains (7.7% and 15.4%). Most constitutive and inducible clindamycin resistance isolates belonged to agr type III (26.2% and 18.5%) and SCCmec type III (each 27.9%). In the present study, 32.3% of the isolates were confirmed as mupirocin resistant, and all were MRSA, 9 (42.9%) and 12 (57.1%) isolates of which exhibited high-level mupirocin resistant (HLMUPR) and low-level mupirocin resistant phenotypes. All HLMUPR MRSA isolates belonged to SCCmec III and recovered from wound samples.

 The emergence of vancomycin-resistant S. aureus strains among PVL-positive S. aureus strains in Iran is a serious alarm and seems to be becoming the greatest concern in the treatment of staphylococcal infections in the healthcare setting. The present study reinforces plausible direct transfers between community and nosocomial PVL-positive S. aureus types.

 Clinical strains of Pseudomonas aeruginosa possess a wide diversity of antibiotic resistance and genetic characteristics.

 This study aimed to determine the antibiotic susceptibility patterns and genotypes of P. aeruginosa isolated from patients with nosocomial infections.

 We tested 149 samples for P. aeruginosa isolation, confirmed by PCR. The Multi, Extensively, and Pan-drug resistant strains were detected through CLSI guidelines. All isolates were subjected to ERIC-PCR genotyping using specific primers. The antibiotic patterns and ERIC types were analyzed statistically using specific software.

 Seventy-six (51%) isolates were confirmed as P. aeruginosa. Among them, 86.8% were determined as MDR, 81.5% as XDR, and 5.3% as PDR. Eight E-types were detected, which belonged to two main clusters with a similarity rate of over 70%. Cluster B, composed of E-types G and H, was a dominant cluster. Interestingly all of these cluster members were isolated from the internal ICU, and we can claim that at least two different colons had been colonized in the internal ICU. Moreover, four PDR strains were detected in this study, three of which possessed E-type G, and the remaining belonged to E-type H.

 Some unique E-types were dominant in ICUs with high diversity in antibiotic resistance patterns, which can be assumed as causative agents for nosocomial infection. The main threat here is regarding the PDR strains. They could be considered nosocomial pathogens and should be deliberated as a critical threat in an emerging hospital outbreak.

 The opportunistic human pathogen, Pseudomonas aeruginosa, is a critical cause of nosocomial infection with high morbidity and mortality rate. Eradication of P. aeruginosa has been troublesome due to its high capacity to develop strong multidrug resistance (MDR).

 The purposes of this study were to define the pattern of antimicrobial sensitivity, typing, and prevalence of metallo-β-lactamase (MBL) and detect the oprD, blaCTX-M, blaSHV, blaTEM, blaIMP, blaNDM, and blaVIM among clinical isolates of P. aeruginosa collected from Tehran hospitals.

 Clinical isolates were collected from hospitalized children in selected hospitals in Tehran from March 2019 to February 2020. The antimicrobial susceptibility test (AST) was performed by the Kirby-Bauer disk diffusion method. Composed disc diffusion tests were performed to screen MBL production. MBLs and extended-spectrum β-lactamases (ESBL) encoding genes were amplified by polymerase chain reaction (PCR). Amplification of the oprD gene were performed for carbapenem-resistant P. aeruginosa. Random amplified polymorphic DNA (RAPD-PCR) Fingerprinting was used for genotyping the isolates.

 A total of 80 P. aeruginosa isolates were collected. Isolates were resistant to cefepime 35%, ceftazidime 20%, ciprofloxacin 22%, tazobactam 16%. Out of 80 isolates, 16 were carbapenems-resistant. Gentamicin, tobramycin, and amikacin had the highest susceptibilities of 85%,90%, and 90%, respectively. OprD, blaCTX-M, blaSHV, and blaTEM were detected in 80(100%), 36(45%),22 (27.5%), 17 (21.25%), and 1 (1.25%) blaIMP and blaNDM, respectively. In this study, the blaVIM gene was not detected in the isolates, and no mutation was observed regarding the presence of an insertion element in the OprD gene. Isolates were divided into 13 and 14 common and single types, respectively.

 P. aeruginosa isolates showed a high rate of β- lactamases production, and the prevalence of carbapenem-resistant, which can be related to different mechanisms, was alarming. On the other hand, the results demonstrated that there was beta-lactam antibiotic resistance and clonal spread among the hospital population. This shows the necessity of molecular surveillance in tracking beta-lactamase-producing strains.